LTC is making me hate nursing!!!

[Angeljho]

I'm a new grad charge nurse in a LTC facility. I've been there for almost 2 months and I'm at the point where I'm literally scared to go to work. At first I floated, and that was ok, but I just became a regular on a dementia/psych floor. The paperwork and charting is sooo heavy, and I'm the only nurse on a 40-bed unit. I know I have to "manage my time" more effectively, but there's not enough time in one 8 hr shift to do everything that is required of me.. and i don't take lunch.

I have to pass meds (and the time schedules of the meds are so crazy), start tube feedings, supervise CNAs, chart, pick up orders, check orders, treatments, and various other paper work that come in books.. and the worst of all is getting an admission.. i always fear that i'll get an admission .. and on top of all that, i JUST learned that i'm required to re-do the whole treatment book for the new month.. and my god, the daily interruptions i get.. supervisors coming every 5 mins to check the medex while i'm giving meds, CNAs calling me for this and that, residents not wanting to take their meds (i have to spend so much time just to encourage them to do so).

I don't want to quit because I want to be able to handle everything, and I've floated to every floor to know that other floors are easier to handle; still hard, but a little easier. I just don't believe one nurse can do it all safely.

[bryanleo9]

On 8/21/2019 at 1:19 PM, Floridasunnurse said:

Interesting that looking through the local indeed ad's for Southwest Florida and having never seen so many listings for DON, ADON and nurses in LTC. I predict going forward that it will be very difficult if not almost impossible to find nurses to take on the responsibility and fill these positions. The workload for everyone involved has just become too much.

They will just sponser foreign nurses to come here in visas and to them it's the best thing ever. And even if it's not, they can't quit as they sign 2 year contracts and don't want to be deported. I have talked extensively with a foreign nurse who was imported to work in these conditions who now works with me. She said it was hell. And yes care gets skipped all the time.

[garciadiego]

On 9/26/2010 at 8:14 AM, Asystole RN said:

Welcome to LTC.

Time management and repitition will be the key.

Once you learn your residents you will know who likes what and when, which will allow you to pass your meds very quickly. It also takes time to learn the paperwork to be able to do it fast.

Give it time and think of it as boot camp. This will be your first test of many as a Registered Nurse :)

There is a limit to "time management"....it is possible to be given so many unrealistic assignments and no amount of time management in hell or earth or heaven is going to help you....I thank the Lord that I was able to put in 37 years working in nursing and able to get out without making any serious mistakes because a incompetent manager gave me an impossible assignments.

[Guest757854]

2 hours ago, garciadiego said:

There is a limit to "time management"....it is possible to be given so many unrealistic assignments and no amount of time management in hell or earth or heaven is going to help you....I thank the Lord that I was able to put in 37 years working in nursing and able to get out without making any serious mistakes because a incompetent manager gave me an impossible assignments.

Exactly! I dont ever want to go back to working in nursing homes. Its just waaaaay to much. I still stay very hopeful LTC will get better....i mean it has to at this point. I dont think it can get any worse.

[Dani_Mila, BSN, RN]

On 9/26/2010 at 2:29 PM, realitycheck1 said:

This is called being used and abused by an employer (corporation). In other words, exploitation. Instead of hiring 3 nurses - they use one nurse to do the job of 3 nurses, paid for one nurse (to save $).

This is the part that I hate about LTC. So true

[LPN Retired, LPN]

On 9/26/2010 at 7:38 PM, itsmejuli said:

Oh heck no! You couldn't pay me enough to safely care for 40 residents.

I have 20 residents to care for on my 12 hour weekend shifts. That's enough to safely handle and get everything done that needs to be done.

Start looking for another job.

You are blessed if you have a job with only 20 residents to care for. I did some LTC, and I had a hall with about 30 pts. It was impossible to get everything done and leave on,time.

[Spooky, RN]

On 1/13/2020 at 7:52 PM, LPN Retired said:

You are blessed if you have a job with only 20 residents to care for. I did some LTC, and I had a hall with about 30 pts. It was impossible to get everything done and leave on,time.

Notice the comment was back in 2010... I started my first job at a nursing home in 2011, had anywhere from 17-21 residents for my hall with a max of 23. I averaged about 20 residents most of the time. Something dramatic changed in my facility in 2015. All of a sudden nurses where being fired for random crap. MAs were hired to make up for the nurse being fired and help the remaining nurse of the wing (no longer "hall"). I then had around 26-28 residents for my wing out of nowhere. We had a low census at that time, but it never mattered before. I could barely handle 28 even though I had an MA half of the time. I started my second job in another nursing home in a different state in 2016. Automatic 26 residents max. Okay, got into the swing of things without an MA and was still stressing out most of the time. All of a sudden the DON wanted us to switch halls periodically, about every 3 months, to get rid of the "comfortable" feeling we all had. Uh, yeah... It would take me about a month and a half to just get a damn med time routine down and an extra month and a half to actually know my residents, their illnesses, habits, family members, etc. just to be switched to another hall? Yeah, got my other hall and BAM! 31 residents... I was DONE. I handled that for a couple of months and bounced. It's crazy. It's abuse to handle that workload to me. Abusive to the nurse and residents. Oh, it was an 8-hour shift, by the way. You know, the 8-hour shift that really should be a 12-hour shift... I usually left at midnight AFTER my shift was over/handed off to the night nurse at 10pm.

Plus, I'm known to be a very organized (some might say PITA) co-worker. I would purchase binders, water pitchers and one time a damn KEYBOARD for my wing. I bought a label maker and labeled everything nicely so we knew exactly what was what at my nurses station. I basically got myself comfortable doing this at all my jobs and my DON always noticed and praised me for it... So, yeah I was moved from time to time just to "sort" crap out. From my second job with the 31 residents, apparently they never switched halls before. It made me wonder why all of a sudden we were switching around. That DON loved my organization from the med cart to the paperwork. It took me lots of time in between everything to just be switched around to clean up somebody else's crap. I had it. We switched and I looked for another job immediately. Anyway, sorry for the long comment! I could go on and on...

[JuliAnn Finger]

Someone once said to me that the patients who used to be deceased are now in the hospital. Patients who used to be in the hospital are now in SNFs and patients who used to be in SNFs are now in ALFs....they just haven't changed the ratio of nurse to patient / resident with the rise in acuity...I find that to be true. When I started nursing they were "nursing homes" and the acuity was nowhere near what it is now. A nurse cannot take care of 30 patients on a shift and see to all of their needs ~ especially with the constant interruptions, even if you "aren't supposed to be interrupted during med pass". The charting is horrific and most of it is done to meet requirements by the state or to CYA for the facility. Admissions and incident reports are nightmares (please ~ who decided that a patient has a "right" to fall?), add treatments to the above and you have a recipe for trouble and the loss of your license. Soon I will retire after 25 years ~ that's if Covid-19 doesn't decide for me that I need to leave earlier for my own sake. I pray that someday money doesn't drive our care and that patient ratios become reasonable but as long as healthcare workers keep soldiering on the corporations will continue as they have been allowed to. If ratios change then you have to hire more nurses which means less profit ~ this is something we must do ~ it won't be handed to us because that's like taking money out of corporations pockets...not gonna happen!

[kbrn2002, ADN, RN]

It's crazy how little has changed since this thread was started 10 years ago. Heck, if anything it's worse now. Used to be 25-30 residents was tough but manageable since almost all of them were in reasonably stable condition. Care was focused more on maintaining their relatively good health. Now with level of acuity skyrocketing focus has shifted to just keeping them all alive.

Don't even get me started with the ever increasing documentation requirements. When I started LTC back in '94 we complained about the charting and how long it took to sign off the paper MARS/TARS. How silly of us! I'd bet the house that every nurse working LTC now would give their left arm to go back to those days. The crazy charting requirements is a big part of why I finally decided to leave.

When it turned into half my shift I was stuck at a computer and still wasn't getting everything charted that management expected I decided enough was enough. There were so many memo's put out that added more and more paperwork and silly busywork that it was truly impossible to keep up with it. What was right one day was wrong the next, and then right again a day or two later. For heaven's sake decide on a policy and stick with it!

There were nurses being disciplined for not charting enough or charting too much and using the "wrong" words that might require follow up by management. I saw the writing on the wall when it got to the point of nurses being genuinely afraid of being written up for missing something in a note that management arbitrarily decided was vital or charting something that despite being true was a red flag.

I decided to leave about the time a nurse was fired soon after charting a resident to resident physical alternation that required a whole lot of follow up. She was a good nurse and while nobody of course could confirm why she was fired we all assumed that was a big part of the reason and pretty much every nurse started being afraid to chart the wrong thing. There could be no documented bad situations, no disruptive resident or family behaviors. Basically only chart that the facility was all sunshine and rainbows despite knowing darn well that wasn't true. But then if a situation occurred and it wasn't documented the brown stuff hit the fan anyway. It was a classic damned if you do damned if you don't situation. There was no winning, no matter what you did or didn't chart it seemed it was the wrong choice.

Then of course everybody knew when a nurse did something wrong, missed doing something, left a box unchecked, an I not dotted or a t not crossed or God forbid charted something management didn't approve of because a "staff education" would occur that sucked up even more of the very thing we didn't have...time! Then of course additional charting was required going forward. This system penalized every nurse for one nurses supposed error. Good for morale, right?

Sorry for the long response but it hasn't been that long since I finally left a job I thought I'd thought I'd stay with until I retired and I am still pretty raw about it. I wondered a little if I did the right thing by leaving. Then I remember all the reason's why I did and know I made the right choice to get out under my own terms before I got caught up the web.

[Dontstressdoyourbest, RN]

Truer words were never spoken.

[S.Matthews_LPN]

Wow, the most I have ever had in LTC was 34, and that was way too many, in my opinion. I currently work at a place that is very disorganized and I have 18 residents. I feel that the staffing issues is playing a role in why I feel like I need to search for another job, but I can't handle more residents. When the nursing facilities pay their own staff less money than agency, allow agency to show up late every day, and then they treat good employees like they are the issue when they speak up, it feels toxic. Oh well, it has become the norm.

[SmilingBluEyes]

I wonder if the OP loves being an NP?

[gooodnitenurse]

I worked in LTC for over 30 years, it does not get better. get out while you are still young and before you become stereotyped. some employers think LTC nurses just care for elderly. they have no idea. 

with an RN degree you can work almost anywhere you want. I don't know  where you live but I would apply at a hospital for operating room, flight nurse, emergency or ICU. some hospitals offer internships. I would encourage you to specialize in an area you are interested in working. good luck to you.